- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,576.00 / $8,400.00
| Facility | | $1,000.00 | $3,576.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,139.54 / $6,529.28 / $10,390.44
| Facility | | $4,139.54 | $6,529.28 | $10,390.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.81 / $1,807.00 / $5,819.45
| Facility | | $703.81 | $1,807.00 | $5,819.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |